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NPI Code Detail

MEDICARE: SUSAN E. STAFFORD P.A.

MEDICARE: SUSAN E. STAFFORD P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist0801KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000393284OTHERANTHEM BCBS

General Provider Information

NPI Number : 1588672836
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN E. STAFFORD P.A.
Provider Business Mailing Address
First Line : PO BOX 790
Second Line :
City : ASHLAND
State : KY
Zip : 41105-0790
Country : US
Telephone Number : 606-329-8588
Fax Number : 606-329-8195
Provider Business Practice Location Address
First Line : 321 E MAIN ST
Second Line :
City : MOREHEAD
State : KY
Zip : 40351-1671
Country : US
Telephone Number : 606-784-4161
Fax Number : 606-784-9952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 11/07/2014

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